Can We Have a Statin Appreciation Day?

Most people in the United States will die of either cardiovascular disease or cancer. There are no guarantees in life, but if you are a gambler—statins are your best bet for a longer life—statistically speaking.

Statins reduce plaque build up in blood vessels and reduce low levels of inflammations.

The FDA has approved statin use for coronary arteriosclerosis and hypercholesterolemia. However statins are also being used off label and studied for the following conditions including various kinds of cancers including:

• Acute coronary syndrome
• Acute myeloid leukemia
• Adenocarcinoma of the stomach
• Adrenoleukodystrophy
• Atrial fibrillation; prophylaxis
• Atrial fibrillation; prophylaxis
• Cerebrovascular accident; Prophylaxis
• Cholesterol ester storage disease
• Coronary artery bypass graft
• Deep venous thrombosis; Prophylaxis
• Degenerative disorder of macula; Prophylaxis
• Dementia
• Dyslipidemia - Transplantation
• Familial type 3 hyperlipoproteinemia
• Heart failure, chronic
• Impaired cognition
• Lung cancer
• Nephrotic syndrome
• Osteoporosis
• Percutaneous coronary intervention
• Postoperative cardiac complication, Noncardiac surgery; Prophylaxis
• Restenotic lesion of coronary artery; Prophylaxis
• Secondary hypercholesterolemia - Type 2 diabetes mellitus
• Trash foot

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Source: Micromedex and other sources

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JACHO, an agency that audits and accredits hospitals and other health care organizations, has made it part of their guidelines that after a person has a heart attack or stroke, that person is to be sent home from the hospital with a statin prescription to restore blood flow to the affected area, usually the brain or heart.

Also, The US Preventive Services Task Force has recently expanded their guidelines for primary prevention to allow more people access to statins. Now, more people at risk of having a heart attack and dying do not have to wait for a heart attack to happen before they are eligible for a statin.¹ Why? Because statins extend life.

Studies have found that the higher the statin dose, the better the mortality rates.

One

-year mortality rates in patients receiving high-, moderate-, and low-intensity statins or no statin therapy, are 4.0%, 4.8%, 5.7%, and 6.6% respectively.²

Also, people who took their statin medication at least 90% of the time had a 45% reduction in the risk of all-cause mortality, compared with less adherent patients.³

So why are so many patients taking themselves off the statins that the doctor has prescribed? It’s true that statins have side effects, but I believe the reason people don't like taking statins is twofold. First health care professionals are not explaining the benefits in terms that patients can relate to. Secondly, non-medical journalists sometimes sensationalize the side effects. They are taught to find a unique angle to the story and spin it to get ratings. They don’t have to worry about malpractice lawsuits.

I tell all my patients to bring any article to me that contradicts their doctor or that they find puzzling. I will thoroughly explain both sides of the story. All medications are both good and bad depending on the situation. As a pharmacist, I am committed to giving both sides of the story so that the consumer can make wise choices.

When I talk to my patients about the benefits of statins, I use words they can understand. I tell them to think of the pluming pipes in an old house that have become clogged. The water flows slowly, if at all. That's similar to what happens in our blood vessels with arteriosclerosis. Statins remove the plaque build up so that life sustaining nutrients, oxygen, and blood can be delivered to the precious cells in our heart, brains, and other vital organs.

When patients bring up diet and exercise as a replacement for statins my response is: It’s true that a consistent and strict regimen of diet and exercise can reduce plaque build up. Dr. Dean Ornish wrote about this and proved that it can be done with a very consistent regimen. However, few patients are willing to make those changes and sustain them for the rest of their life. Even if they do achieve and sustain the strict changes required, the amount of plaque being removed as a result of diet and exercise is less than the amount being removed from statins.⁴

Statins plus diet and exercise is the way to go. It yields the best results. I caution patients for doing diet alone unless they are highly motivated. I remind them of people who have gone on a diet to lose weight and end up gaining weight. I tell my patients that if their doctor prescribes a Statin, I HIGHLY recommend they take it while they pursue diet and exercise. It is their best bet (statistically speaking) for a longer life.

References

1. US Preventive Services Task Force. Statin use for the primary prevention of cardiovascular disease in adults. US Preventive Services Task Force Recommendation Statement.

JAMA

. 2016;316:1997-2007.

2. Rodriguez F, Maron DJ, Knowles JW, Virani SS, Lin S, Heidenreichz PA. Association between intensity of statin therapy and mortality in patients with atherosclerotic cardiovascular disease. JAMA Cardiol. Published online November 9, 2016. http://jamanetwork.com/journals/jamacardiology/article-abstract/2580531. Accessed November 11, 2016.

3. Shalev V, Chodick G, Silber H, et al. Continuation of statin treatment and all-cause mortality. Arch Intern Med. 2009; 169:260-268.

4. Jula A, Marniemi J, Huupponen R, Virtanen A, Rastas M, Rönnemaa T. Effects of diet and simvastatin on serum lipids, insulin, and antioxidants in hypercholesterolemic men: A randomized controlled trial. JAMA. 2002;287(5):598-605.